435200727-1-28-2026-26-AS-CKAI-DR5QH3-20260209111025

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435200727
Report Date: 01/28/2026
Date Signed: 01/28/2026 04:14:32 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/23/2026 and conducted by Evaluator Marcela Yanez

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20260123145949

FACILITY NAME:	CARLTON PLAZA OF SAN JOSE		FACILITY NUMBER:	435200727
ADMINISTRATOR:	SHANTELA YADAO		FACILITY TYPE:	740
ADDRESS:	380 BRANHAM LANE		TELEPHONE:	(408) 972-1400
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95136
CAPACITY:	183	CENSUS: 137	DATE:	01/28/2026
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Shantela Yadao		TIME COMPLETED:	04:25 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility did not provide resident with a refund
Staff are not communicating with responsible party regarding resident's care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced initial complaint investigation visit and met with Shantela Yadao, Administrator. LPA announced the purpose of the visit.

On 01/23/26 the department received a complaint with the above allegations.

During visit LPA obtained pertinent documents for R1 and interviewed staff and Administrator.

During the investigation LPA reviewed Deposit Receipt effective date 10/31/25 signed by Resident Responsible party on 10/29/25. Admissions agreement and email communication between POA and staff.

Resident (R1) moved into the facility on 10/31/25 after being assessed by Sales Manager and virtual assessment by nurse at hospital. Sales Manager stated resident did not exhibit behavior at that time of assessment.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 26-AS-20260123145949

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: CARLTON PLAZA OF SAN JOSE	FACILITY NUMBER: 435200727
	VISIT DATE: 01/28/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Page 2 of 2

The Deposit Receipt dated and signed by POA on 10/29/25 states that the R1 Community Fee is fully refundable until the Personal Care Interview is completed. After the assessment has been completed $500 dollars of the fee is non refundable. Any balance would be refunded on a pro-rated basis, 1st month is 80% and 2nd month is 60% and 3rd month 40% and after 3rd month is no refund.

4 out of 4 staff stated that R1 exhibited behavior shortly after moving in and POA was notified that R1 might need 1 on 1 care. 4 out of 4 staff stated the POA was informed of change in condition and R1s emergency contact was also notified.

S2 stated he/she would call POA when resident had behavior and stated POAs voicemail was not set up and they would call R1s emergency contact who lived nearby. The Residents progress notes stated emergency contact was notified regarding R1s needing refill of medication and when R1 was having behavior.

Based on interview and record review the facility refunded the amount of $2500.00 dollars for community fee of 60% of $5000.00 which is a total of $3000.00 minus the $500 non refundable fee that was stated on Deposit Receipt signed by POA. The check was issued on 01/20/26 and was delivered on 01/21/26 and another refund check for $258.00 for 1 day of rental fee when resident moved out on 12/30/25 was sent on 01/13/26.

The Department has investigated the above allegations. Based on interviews, and observation the above allegations are unfounded meaning the allegations is false, could not have happened, and/or is without a reasonable basis.

No deficiencies were cited at this time as per California Code of Regulations Title 22.

This report was reviewed with Shantela Yadao and a copy of this report was provided.

SUPERVISORS NAME: Christine Kabariti
LICENSING EVALUATOR NAME: Marcela Yanez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2